Medicaid's inspector general recouped millions in first year

SALT LAKE CITY — Utah's Medicaid inspector general has recouped millions in his first year at the helm of an office charged with uncovering wasted funds and suspected fraud.

Lee Wyckoff told lawmakers in the Health and Human Services Interim Committee Wednesday that he has opened investigations on more than 800 cases in the state, 10 of which have resulted in recovered taxpayer money. Approximately $7.9 million is the pay back so far and he said an additional $17.6 million is under review.

The office has also conserved about $3 million that would have been misused had it not been for policy changes, he said.

"We're a good return on your investment," Wyckoff said, adding that overhead and administrative costs to run the office add up to about $1.6 million.

The office was created in 2011, following multiple state and legislative audit reports that revealed upcoding, where providers billed Medicaid for more costly services than were rendered, and other problems with the state's Medicaid budget. The post is charged with decreasing costs and recouping "improperly paid Medicaid funds," according to the law that accompanied the creation of the position.

Wyckoff said most of what the office has uncovered so far is not malicious fraud, but rather mistakes or unintentional billing issues.

The team is responsible for generating ideas to identify innacurate claims and abuse of the system by providers.

One example includes a recent finding where Medicaid was billed twice each day for patients who had been transferred to hospitals from nursing homes. State funds were being used to cover both costs when only one is valid, Wyckoff said.

Using ambulances to transfer patients from one hospital to another was another area of misuse uncovered by the office of inspector general in the past year, as well as a trend where individuals visit the emergency room to get prescription drugs, rather than talking to their regular doctor.

The office also keeps an eye on procedures that should only be covered by Medicaid once in a given period of time.

Sen. Allen Christensen, R-Ogden, said, "People know you're there and they're paying attention to what you do and they're being more careful."